Health Care for Foreign Born Students

DISCLOSURE

• I have no conflicts of interest in this presentation.

• There will be no discussion of medication off‐label use.

• Susan Hammerton, MSN• SESSION NAME: HEALTH CARE FOR FOREIGN BORN STUDENTS• CASBHC conference May 2nd, 2013.

OBJECTIVES

• Provide a checklist of screening tests for students who were born outside of the US.

• Provide an overview of mental health needs.

• Open dialogue and explore how to improve our health care services to this population of students.

• Refugee – a person who flees to a foreign country to escape danger and persecution via the United Nations High Commissioner of Refugees.

• Asylum Seekers – protection from arrest or deportation given to political refugees. Often come into the USA without documents and then seek asylum status from the embassy.

• Immigrant with papers – A person who comes into the country to take up permanent residence

• Immigrant without papers – Came across the border without permission to seek work.

Where do refugees come from?Recent arrivals ---• Myanmar (Burma) • Iraq• Ethiopia• Afghanistan• Somalia• Iran• Eritrea

• One can look up what is happening in the individual countries on a website called UNHCR - www.unhcr.org on the home page in the upper right hand corner is a search called browse by country which brings up the current profile and situation of that country.

USA accepts 70,000 refugees per year.

About 2,500 get to Denver, CO. each year.

Immigrants

• Number of children 0-17 years old in Colorado per 2000 census: 1,053,066

• 16.1% in immigrant families

• 72% are fluent in English

• 39% are fluent in English yet speak another language at home

Where are immigrants from in Colorado

• 57% Mexico• 12.5% Europe• 10% East Asia• 5.5% Indochina• 4% West Asia• 3% Central America• 2.5% South America • 2% USSR• 2.5% Africa• 1% Caribbean

Health Services

• Need a health exam prior to being accepted as a refugee.

• Some come with a clear status• If have an A status; usually refused entry into

the USA unless have an anchor relative and are seen for health care within 7 days (active TB, leprosy, HIV)

• Others with B1,B2, B3 – have a problem and need to seek health care within one month.

• Upon getting to the U.S. some of the health care is repeated just to use U.S. labs.

• ARRIVAL

in the U.S.

Linguistic Competency

• Language – how to talk to these folks?• Denver Health has a language line• Must have a speaker phone. • I try to be concise in what I have

translated. Anticipate what the discharge instructions are. I have the extreme advantage of being in the school and being able to get kids back in when needed.

The First Encounter

• PPD done stateside

• HIV if over 13 years old

• O&P stool sample

• Physical exam

(including hearing and vision)

• Hematocrit

• Review of Immunizations

Physical Findings

• Perforated TMs• Dental Caries• Anemia• PPD positive – mostly Latent TB• Amebas• Underweight(draw CBC, Chem 20, TSH, sed rate and

do a UA)

Classifications of Tuberculosis

• TB class A – active – needs direct observed treatment (DOTS)

CXR positive with one positive AFB sputum smear• Class B1 – clinically active non infectiousCXR positive and 3 negative AFB smears• Class B2 – not clinically active. CXR positive for other lung condition• Call B3 – CXR abnormal compatible with old or healed

TB.• Latent TB –PPD 10 mm or greater and CXR negative

Other examples of Class B health conditions

• Pregnancy

• High blood pressure

• Diabetes

• Tell me your story

• Ask them if they have seen bad things happen.

TRAUMA SCREENHave you ever been ……….• in a Natural disaster – fire, earthquake, flood• in a bad accident• in place with war going on around• physically abused• threatened with physical harm or separated from home• a witness to violence between your parents• a witness other family members fighting or being hurt at home• beaten up, shot at, or threatened to be hurt badly• a witness to someone being beaten up, shot or killed• seen a dead body other than at a funeral• sexually molested or abused or raped• a witness to someone being sexually abused or molested• experienced the loss of someone very important • experienced painful or scary medical treatment• kidnapped• neglected, left alone or severely ignored• experienced anything else you would consider to be traumatic.

S & S of PTSD• Re-experiences the trauma – dreams, flashbacks thought• Avoids any reminders of the trauma• Diminished interest or participation in activities• Detachment or estrangement• Restricted affect• Increased arousal• Guilt• Difficulty concentrating• Increased arousal – hyper vigilance = increased resting pulse• Guilt• Irritability overactivity• Dissociation spaciness• Difficulty sleeping nightmares• Hopelessness foreshortened future• Worry separation anxiety• Somatization.

• Assimilation – the process of receiving new facts or of responding to new situations in conformity with what is already available to consciousness

• Acculturation – cultural modification of an individual,group or people by adapting to or borrowing traits from another culture.

• The students rate of assimilation versus their parents.

• Boxing for Cuba by Guillermo Vincente Vidal. Gave a great example of not speaking spanish so as not to have an accent and gain the most possible from living in the US.

Undocumented versus documentedimmigrants

• Plyer versus Doe 1982 decided that all kids no matter what their legal status have the right to an education in the US through high school

• Yet if a student can never become a citizen or resident and get a SS# - they often have no motivation to finish school

• Just Like Us by Helen Thorpe is a nonfiction account of 4 mexican girls.

KNOW your OWN cultural stuff!

• One can never know everything there is to know about other cultures.

• The whole hot and cold thing……• In refugee camps they are told to wait in

their tent until told what to do versus initiating everything for yourself and family in the U.S.

• A South High Student explained – open your ears and listen.

8 dimensions of US culture

• Time and its Control• Task versus Relationship• Comfort with Change• Self Sufficiency• Personal Control over Destiny• Status – addressing someone formally is not

important to us usually.• Language – we are direct and that is okay• Individualism

REFERENCES

• Dimensions of Culture Newsletter/ January 2010 by Marcia Carteret